title: Meaning and methadone: patient perceptions of methadone dose and a model to promote adherence to maintenance treatment.
abstract: OBJECTIVE
  Methadone maintenance treatment (MMT) effectively reduces illicit opioid use and its negative consequences when patients participate in and adhere to treatment. Patients' participation and adherence may relate to their perceptions about methadone doses and dose adjustments and the meanings that patients associate with treatment. This study assessed patient perceptions about methadone dosing and the meanings associated with methadone treatment to better support patient adherence to and success in MMT.
  
  
  METHODS
  We conducted semistructured interviews with 19 patients in an urban MMT program. Interviews were transcribed verbatim and analyzed through an iterative process.
  
  
  RESULTS
  Participants' expressed perceptions about methadone doses related to ideas of "comfort" and "function," suggesting a model for determining dose appropriateness and "ideal" methadone dose based on various factors both intrinsic and extrinsic to MMT. Intrinsic factors included those exerting downward pressure on "ideal" methadone dose such as lack of control in treatment, disdain for getting "high," concerns about methadone dependence, and desire to avoid adverse effects; those exerting upward pressure such as concern about withdrawal; and those exerting mixed pressures such as methadone formulations. Extrinsic factors included those exerting downward pressure such as shame about and stigma around MMT; those exerting upward pressure such as medical conditions and medication interactions; and those exerting mixed pressures such as family and peer relationships.
  
  
  CONCLUSIONS
  Participants held perceptions about methadone dosing that included considerations beyond typical medical parameters used by physicians and other MMT providers to determine appropriate methadone doses. The model that emerged from our data could help inform MMT providers to support greater patient comfort with methadone doses and dose changes, as well as adherence to and success in MMT.
authors.affiliation: From the Montefiore Medical Center (JJS, SCL) and Albert Einstein College of Medicine (JJS, RJR, MCL, SCL), Bronx, NY.
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Sanders
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Roose
authors.forename: Michael C
authors.initials: MC
authors.lastname: Lubrano
authors.forename: Sean C
authors.initials: SC
authors.lastname: Lucan
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006556:Heroin Dependence / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D008960:Models, Psychological; D058850:Opiate Substitution Treatment / Q000379:methods / Q000523:psychology; D010358:Patient Participation / Q000523:psychology*; D057545:Social Stigma; D012944:Social Support
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone